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Prevalence and risk factors of urinary tract infection among children with bronchiolitis
1King Abdulaziz University Hospital, Saudi Arabia.
Insights
Urinary tract infection (UTI) is more common in hospitalized children with bronchiolitis than previously thought. This highlights the need for careful screening and diagnosis in these young patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- The co-occurrence of bronchiolitis and urinary tract infections (UTI) in hospitalized children presents significant morbidity and economic challenges.
- Low reported prevalence (<3%) and inconsistent diagnostic criteria fuel debate on the necessity of systematic UTI screening in bronchiolitis cases.
- This study aimed to determine UTI prevalence in children hospitalized for bronchiolitis and identify associated demographic and clinical factors.
Purpose of the Study:
- To estimate the prevalence of urinary tract infections (UTI) in children admitted with bronchiolitis.
- To analyze demographic and clinical factors associated with UTI in this patient population.
- To evaluate the utility of diagnostic criteria and imaging in identifying UTI in children with bronchiolitis.
Main Methods:
- A 5-year retrospective chart review (2016-2020) of children admitted for bronchiolitis at a pediatric referral center in Jeddah, Saudi Arabia.
- UTI diagnosis adhered to American Association of Pediatrics criteria, utilizing urine culture and urinalysis data.
- Extraction of demographic, clinical, microbiological, and imaging data from electronic health records.
Main Results:
- Based on urine culture, UTI prevalence was 13.1% (95% CI 9.6-17.3), with E. coli and K. pneumoniae as common pathogens; 31.0% of isolates were ESBL-producing.
- Using urinalysis criteria (pyuria/nitrituria), UTI prevalence decreased to 3.4% (1.7-6.1%), with K. pneumoniae and E. coli as primary pathogens; 6/11 isolates were ESBL-producing.
- Regurgitation was linked to a higher UTI risk (5.3% vs. 0.8%, p=0.031). Urinary tract ultrasound demonstrated high specificity and NPV for UTI detection.
Conclusions:
- A higher prevalence of UTI exists among children with bronchiolitis at the study center, impacting screening, diagnosis, and management strategies.
- Further multicenter research is essential to confirm these findings and evaluate the cost-effectiveness of national UTI screening protocols.
- The study underscores the importance of considering UTI in hospitalized children with bronchiolitis, particularly those with risk factors like regurgitation.
Background:
The co-occurrence of bronchiolitis and urinary tract infections (UTI) in hospitalized children is associated with high morbidity and economic strain. However, due to a low prevalence (<3%) and inconsistent diagnostic criteria, there is ongoing debate regarding the necessity of systematic screening. This study estimated the prevalence of UTI among children admitted for bronchiolitis and analyzed the associated demographic and clinical factors.
Methods:
A 5-year (2016-2020) retrospective chart review was conducted among all children admitted for bronchiolitis at a referral pediatrics department in Jeddah, Saudi Arabia. UTI was diagnosed according to the American Association of Pediatrics criteria. Demographic, clinical, microbiological, and imaging data were extracted from the hospital electronic records.
Results:
Of the 491 cases of children with bronchiolitis, urine culture and analysis were available for 320 patients. Based on urine culture criteria alone, the prevalence of UTI was 13.1% (95% CI 9.6-17.3), and the most common pathogens included E. coli (33.3%), K. pneumoniae (23.8%), and Enterococcus faecalis (14.3%), and 13 (31.0%) of the isolates were EBSL. By considering urinalysis criteria, i.e., pyuria or nitrituria, the estimated prevalence of UTI decreased to 3.4% (1.7-6.1%), and the most common pathogens were K. pneumoniae (5/11) and E. coli (3/11), with 6/11 ESBL-producing isolates. Regurgitation associated with a higher risk of UTI compared to absence of regurgitation (5.3% versus 0.8%; p = 0.031). Urinary tract ultrasound showed high specificity (98.7-100%) and negative predictive value (97.4-97.7%) in UTI using either criterion.
Conclusions:
There is a higher prevalence of UTI among children with bronchiolitis in the study center, which has several implications in screening, diagnosis, and management. Further multicenter studies are required to enhance the external validity of these findings and assess the cost-effectiveness of screening strategy at a national level.
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